Back to 2024 Display ePosters
Patient-prosthesis Mismatch After Aortic Valve Replacement With Mechanical Prostheses
Vadim Popov, MD1, Amiran Revishvili
1, Egor Malyshenko
1, Magomed Gasangusenov
1, Madina Kadyrova
1, Natalia Popova
1, Natalia Ardashova
1, Mihail Svetkin
2, Vladislav Aminov
2;
1A.V. Vishnevsky National Medical Research Centre of Surgery, Moscow, Russian Federation,
2Federal State Center of Cardio Vascular surgery (Chelyabinsk), Chelyabinsk, Russian Federation
BACKGROUND: . The hemodynamic characteristics of implantable prostheses directly affect the outcomes of surgery, in some cases leading to the development of the prosthesis-patient mismatch syndrome (PPM), especially in patients with a narrow fibrous ring. The frequency of this syndrome after aortic valve replacement reaches 34.2%. The development of new and modification of existing models of mechanical prostheses allows to reduce the incidence of PPM, regardless of the size of the fibrous ring.
METHODS: In a retrospective study, the analysis of aortic valve replacement results in 83 patients was conducted. Among them, 43 (51.8%) patients received mechanical prostheses with landing sizes of 19 and 21 mm (Group 1, study group), and 40 (48.2%) received prostheses sized 23 and 25 mm (Group 2, control group).The risk of PPM was assessed by the indexed effective orifice area of the prosthesis (IEOA). The mismatch between the prosthesis and the patient (PPM) was defined as severe when IEOA was <0.65 cm2/m2, moderate when IEOA was - 0.65-0.85 cm2/m2. The average age of patients did not significantly differ, and was 57.9±14.9 years in group 1 and 57.6+13.3 years in group 2. The peak gradient before surgery in the study and control groups was significantly different: 85.8±27.9 and 68.5±28.3 mmHg, respectively. The mean gradient also differed significantly: 48.8±17.6 and 38.4±15.6 mmHg, respectively. The prostheses were implanted in the supra-annular position in all cases.
RESULTS: The CBP time and aortic occlusion time in the study group (152+35.9min and 99+27.7min) did not significantly differ from the control group (143+25.9min and 95+21min).The peak gradient after surgery in the study and control groups did not show significant differences: 20.8±7.2 and 16.3±4.7 mmHg, respectively. The mean gradient also did not differ significantly: 10.2±4.1 and 8.5±2.9 mmHg, respectively. The IEOA in both groups revealed an expected significant difference; however, neither group exhibited severe PPM syndrome. Moreover, the majority of the patients in both groups had IEOA values above 0.85 cm²/m².
CONCLUSIONS: The analysis of long-term results within a period of up to 5 years shows that low-profile double-leaf mechanical prostheses are effective regardless of the size of the fibrous ring, providing adequate values of IEOA and reducing the risk of developing severe PPM to a minimum.
Back to 2024 Display ePosters
